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Home My WebLink About28924-ZFORM NO. 4 TO,TN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPARCY No: Z 29611 Date: 07/31/03 T~IS CERTIFIES t~at the building ADDITION Location of Property: 1400 MARLENE LA LAUREL (HOUSE NO.) (STREET) (HAMLET) County Tax Map NO. 473889 Section 144 Block 2 Lot 36 S%~bdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated NOVEMBER 15, 2002 pursuant to which Building Permit No. 28924-Z dated NOVEMBER 18, 2002 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is FIREPLACE ADDITION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to STEVEN SZCZESNIAK (OWNER) of the aforesaid building. SUFFOLK COL~I~fDEPi~RTI~OF~F~%L~{APPROVi~Ja ELRC~rKIC-~L CERTIFICAI~ NO. PLUMBERS CERTIFICATION N/A N/A N/A //~t~rized Signature Rev. 1/81 FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUII~DING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 28924 Z Date NOVEMBER 18, 2002 Permission is hereby granted to: STEVEN SZCZESNIAK 1420 MARLENE LANE HATTITUCK,NY 11952 for : FIREPLACE ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at 1400 MARLENE LA LAUREL County Tax Map No. 473889 Section 144 Block 0002 Lot No. 036 pursuant to application dated NOVEMBER 15, 2002 and approved by the Building Inspector to expire on MAY Fee $ 150.00 ORIGINAL Rev. 5/8/02 Form No. 6 TOW31 OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Plmming Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: l. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy- $.25 4. Updated Certificate of Occupancy- $50.00 Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction: Location of Property: House No. Owner or Owners of Property: Suffolk County Tax Map No 1000, Section Subdivision Old or Pre-existing Building: Permit No..~-~ '~.-2~2 Date of Permi Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ __.~_ ~,,- ~'~ Street J(check one) / Hamlet Block Filed Map. Lot: f///~/o ~--Applicant: Underwriters Approval: Final Certificate: (check one) Applicant Sig~e ~__~ ~ BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ]~I~NG [ ] FINAL FIREPLACE & CHIMNEY 765-~802 BUILDING DEPT. INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. [ ] ~IDATION 2ND [ ]INSULATION [/~ FRAMING [ ] FINAL FIREPLACE & CHIMNEY DATE 765-~,802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION2ND [ ] INSerTION [ ] FRAMING [ ~"~FINAL [ ] FIREPLACE & CHIMNEY DATE INSPEG~rOR ~~~'~ TOWN OF SOUTHOLD TO.WN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. northfork.net/Southold/ Examined Approved Disapproved a/c Expkafion BUILDING PERMIT APPI~CATIDN CHECKLIST Buildin Do you have or need the following, before applying? Board of Health ~' 3 sets of Building Plans Planning Board approval .,, Survey. ~ Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: Phone: Inspector APPLICATION FOR BUILDING PERMIT Date/~dL~'c,m/J~r~_ /~ , 20~'2~ INSTRUCTIONS ' filled in by typewriter or in ink and submitted to the Building Inspector with 3 sets c accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an addition six months. Thereafter, a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction ofbuildmgs, additions, or alterations or for removal or demolition as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applican o~e, if a corpor'~-~-on) (M~i~th~ ad~ress of applicant} State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Locatioja of land on which propose.~d work will be done: /. p2,o 1195'-2- s" House N~b~ S~eet H~let Co~,T~MapNo. 1000 Section /~ aa Block Subdihsion Filed Map No. 2. State existing ~xse anckoccupancy of premises and intended use and occupancy of proposed construction:, a. Existing use and occupancy b. Intended use and occupancy_ d~a'~/'r:~-~,-~'"C 3. Nature of work (check which applicable): New Build'rog Repair Removal Demolition 4. Estimated Cost 7~::t~::9- '-- Fee 5. If dwelling, number of dwelling units If garage, number of cars ~,~ Addition Alteration Other Work t~'J,'-)~o.-.oe-~ (Description) (To be paid on filing this application) Number of dwelling units on each floor ~ If business, commercial or mixed occupancy, specify nature and extent of each type of use. - ~-~ Dimensions of existing structures, if any: Front ~,'/ Rear _Depth ~ Height ,/~=, / Number of Stories Dimensions of same structure with alterations or additions: Front .~// Rear Depth. '2.'~ · ~'~,:> Height. /t~ / Number of Stories o 9. Size of lot: Front 10. Date of Purchase Dimensions of entire new construction: Front Height Number of Stories Rear .Depth Name of Former Owner[,Jt~ ,,~/~'~-- 11. Zone or use district in which premises are situated JO~>~::> 12. Does proposed construction violate any zoning law, ordinance or regulation? YES_~NO ~ 13. Will lot be re-graded? YES__ NO v/Will excess fill be removed from premises? YES __ NO ~ ~., 14. Names of Owner of premises Name ofArchitect.,~'~)f~q~dOe~r~ ~,~"'~ Name of Contractor 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES__ * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet ora tidal wetland? * YES__ NO / * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. STATE OF NEW YORK) COUNTY OF~S: · ~ ,~/~//~~.~ being duly swom, deposes and says that (s)he is the applicant //(Name of indiyi~ua~qs-i~dr~g ~ontract) above named, (S)He is the (Contractor, Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and f'de this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this [ f~:,--rx4-- dayof k~OJ~''-mr~ru- 20 0'2~- Signature of ~_)~lic°ant ~ St'ate of Hew Yod~ Ucensed L~nd Surveyors WILUA:a R. $~UUONS. 3rd Ho. 49237 SUr~VE!EO /~¢~"~/~-~ · 19Z~~ BY WILLIAM R SIMMONS I11 138 WOODLAND ST EAST LC. LIP L ! 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